HealthSure Claims are adjudicated through MSH International in Calgary.
Clients who have HealthSure Insurance can call the Claims department as soon as they are placed on a medical wait list. HealthSure works in conjuction with the Canadian Healthcare System. If the wait list is over 45 days in length, then the HealthSure plan kicks in.
Unfortunately, sometimes it is unclear how long a client must wait for a specific procedure as many doctor offices will not provide an actual timeline unless asked. It is important to discuss this with your doctor to receive a firm answer from them to give to our Claims department.
IMPORTANT: Quote your name and certificate number on all correspondence with MSH.
To obtain authorization please forward the all pertinent information to MSH International.
To determine eligibility the Insured Person MUST provide the following:
Proof of referral for medical specialist, diagnostic or surgical procedure;
Proof that the scheduled appointment date for medical specialist, diagnostic or surgical procedure is greater than 45 days from the date that the referral was made;
In the event that confirmation of a scheduled appointment date cannot be obtained, documentation from the medical specialist, diagnostic or surgical facility, who will be performing the service, will be required. This document needs to state that you are on a waiting list and unable to get an appointment within 45 days or state the earliest anticipated possible date that an appointment will be scheduled;
If the insured is unable to obtain documentation of an appointment, when 45 days from the referral date has elapsed it is assumed that an appointment is unavailable.
This Policy does not cover expenses directly or indirectly related to the cost of obtaining or copies of;
Referral for medical specialist, diagnostic or surgical procedure;
Any fees incurred are the responsibility of the claimant.
Supporting documents and medical notes from referring medical physician and/or specialist;
If an Insured member does not have medical specialist, or facility for diagnostic or surgical procedure please contact MSH International for assistance.
To expedite the process to determine claim eligibility, we would suggest that you request copies of the referral, supporting documents and medical notes from your medical practitioner. When information is requested by “us”, on your behalf, the average response time is 8 weeks which can cause a significant delay the claims process. When information is requested by the patient the normal turnaround time is typically much faster.
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Acure Health is the distributor of HealthSure (Medical Access Insurance). Our products are sold exclusively by licensed insurance representatives.
Please have your benefit consultant or insurance agent contact us. If you require an agent, we can provide you with names of licensed representatives in your area.
In the event an insured person obtains diagnostic, specialist, or surgical services without the prior authorization of the Insurer, such service is not eligible for reimbursement.
CLAIMS PROCEDURES – Applicable to All Products
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